Provider Demographics
NPI:1649488420
Name:PALTA, ANOOP K (MD)
Entity type:Individual
Prefix:DR
First Name:ANOOP
Middle Name:K
Last Name:PALTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:P.O. BOX 5720
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32247-5720
Mailing Address - Country:US
Mailing Address - Phone:302-651-4488
Mailing Address - Fax:407-650-7578
Practice Address - Street 1:1350 HICKORY STREET
Practice Address - Street 2:HOLMES REGIONAL MEDICAL CENTER
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-434-7208
Practice Address - Fax:321-434-5344
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME98082208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02553OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FLME98082OtherFLORIDA MEDICAL DOCTOR LI
FL278612500Medicaid